Barriers to cervical cancer screening in a developing Middle Eastern country: A nationwide survey.
Authors: Ahmed A Abdulelah, Zaid A Abdulelah, Jehad AlSamhori, Lina AlQirem, Ahmad Al-Qirem, Abdel Rahman AlSamhori
Journal: Journal of Clinical Oncology (2023)

10545 Background: In addition to being ranked as the 4 th leading malignancy worldwide, cervical cancer is associated with considerable morbidity and mortality resulting in significant burden. However, cervical cancer screening is available and has been proven to significantly minimize the associated morbidity and mortality through early detection. The identification of the barriers towards cervical cancer screening in Jordan, a developing middle eastern country, is of outstanding significance towards effective intervention and minimizing the collective health and socioeconomic burden imposed. Methods: The first consecutive 695 females aged 25 years and above with no prior history of cervical cancer and residing in Jordan across the different regions were enrolled via random probability sampling through a self-reporting survey that comprises of extensive questions regarding the participant’s demographics, medical history, awareness about cervical cancer and its screening methods. Single females were not included in the study due to culture unacceptability of performing pap smears on unmarried females. Statistical analysis was performed to identify the key barriers towards cervical cancer screening in Jordan. Results: The mean age of the enrolled participants was 42 ± 9 years with the majority of the participants having a higher level of education (84.5%), are medically insured (72.4%), and are non-smokers (74.7%). The majority of the participants, 77.7%, did not report a family history of cervical cancer. 472 participants (67.9%) were aware of the availability of a screening modality for cervical cancer, with the majority being informed through awareness campaigns (64.7%). Nonetheless, only 30.1% of the participants previously underwent pap smear for screening purposes. When the participants who did not undergo previous cervical cancer screening were compared with those who did, the participants who did not undergo any prior screening were more likely to identify the lack of information and knowledge towards screening (49.0% vs 9.6%) (p-value &lt; 0.001), fear of the results (81.5% vs 7.2%) (p-value = 0.016), lack of belief in screening and its efficacy (2.1% vs 0.0%) (p-value = 0.037) as crucial and leading barriers. Additionally, the presence of a positive family history for cervical cancer was identified as a statistically significant promoter for screening uptake (p-value = 0.004). Nonetheless, there was no statistically significant difference between the two groups when evaluating the financial aspects of screening or embarrassment from the test as potential barriers, p-value = 0.159 and 0.738, respectively. Conclusions: Lack of knowledge towards screening and belief in its efficacy, and fear of the results were identified as driving barriers towards screening. Effective formulation of comprehensive awareness campaigns is pivotal towards successful intervention to the reported barriers.